JMSCR Vol. 03 Issue 08 Page August 2015

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1 Impact Factor 3.79 ISSN (e) x DOI: A Study of Current Outbreak of Dengue Fever in Children Authors Tamil Selvan 1, Pawan Kumar.S 2,Giridhar 3, Narayana Swamy 4, Mahesh Kumar 5 Department of Paediatrics Sri Lakshmi Multispeciality Hospital, Narayana Superspeciality Hospital, Mallige Hospital, Maruti Hospital,Bangalore, Karnataka, India - drselvantg@yahoo.com ABSTRACT Background: Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. The Objective of the present study is to study the clinical profile of dengue fever in children because of lack of such research among children. Material and methods: Prospective study was conducted on all the laboratory confirmed cases of dengue fever during the outbreak of dengue fever from May 2015 to July 2015 among 300 children admitted to 4 major hospitals in Bangalore, Karnataka, India. Results: Among 300 patients studied, majority of them were males (56.6%) and in the age group of 6-10 years (36%). The most common symptoms were fever (97.3%) followed by headache( 86.6%) myalgia (86.6%),decreased appetite (83%), retroorbital pain (67.7%), abdominal pain (66.6%) and vomiting (64.3%). The most common signs were skin rash (57.3%) and hepatomegaly (14.3%). The most common complications seen were hepatic dysfunction (11%) followed by pleural effusion (3.6%) and shock (2.3%).Mortality was nil in our study. Conclusion: Clinical profile resembles with other studies but with low severity and most common complication being hepatic dysfunction. Community awareness, early diagnosis and management and vector control measures and vaccination need to be strengthened in order to reduce the increasing number of dengue cases. Keywords: Dengue fever, complications, hepatic dysfunction, shock, skin rash Introduction Dengue infection is a emerging disease and is a major health problem in our country. Globally the incidence of dengue has increased in the recent years. The WHO estimates that presently about two fifths of the world population is at risk for this viral infection. 1. Dengue fever was first reported by Benjamin Rush in 1780 as break bone fever. It is a mosquito borne viral infection with four serotypes causing severe dengue fever, dengue with warning signs, and dengue without warning signs. 2 It is estimated that worldwide nearly 2.5 billion people continue to live at risk of contracting the infection while 50 million cases and 24,000 deaths tend to occur in 100 endemic countries. Risk of mortality in treated cases of is Tamil Selvan et al JMSCR Volume 03 Issue 08 August Page 7017

2 less than 1% while mortality rate among untreated cases escalates to 20%. 3 India is one of the seven countries in the South- East Asia region regularly reporting incidence of dengue outbreaks due to its high incidence which constantly threatens the health care system. The first confirmed case of dengue infection in India dates back to 1940s, and since then more and more new states have been reporting the disease which mostly strikes in epidemic proportions often inflicting heavy morbidity and mortality. 4 Several fatal forms of the disease, severe dengue fever have been reported in India from time to time in Kolkata, Delhi, and Chennai. 5-8 All the four serotypes of the virus have been in circulation and reported in Tamil Nadu. 9 During all these epidemics infection occurred in all the age groups and more so in adults in the age group of years. 10,11 The common symptoms and signs observed were fever, headache, myalgia, arthralgia, bleeding manifestations and shock have also been observed. The exact clinical profile in children is important for patient management and thereby saving the life. The objective of the present study is to study the clinical profile of dengue fever in children. Material And Methods This hospital-based descriptive study with prospective data collection were carried out at the 4 major hospitals Sri Lakshmi Multispeciality Hospital, Narayana Super specialty Hospital, Mallige Hospital, Maruti Hospital, Bangalore, Karnataka, India during the latest outbreak of dengue fever for a period of 3 months from May 2015 to July 2015.All the admitted patients were enrolled on a structural protocol which included symptoms, signs, diagnosis, complications, relevant investigations,treatment, duration of stay and outcome. Relevant data was entered in a proforma and analyzed. The diagnosis of dengue fever was based on the WHO criteria 3. Inclusion criteria 1. Children with age group of 0-18 years 2. Admitted with symptoms of dengue fever based on WHO criteria 3. NS1 antigen and IgM dengue antibodypositive cases by ELISA technique Exclusion criteria 1. Children with IgG dengue antibody positive 2. Children with malaria and enteric fever Results A total of 300 cases admitted to the 4 major hospitals in Bangalore during current outbreak from May 2015 to July 2015 were statistically analyzed. According to the age majority were in the age group of 6 10 years 36% (108/300) followed by more than 10 years with 31%(93/300),among sex males were more common 56.6% (170/300). With reference to the symptoms fever was the most common symptom with 97.3% (292/300) followed by headache 86% (260/300) and myalgia 86% (260/300). The other predominant symptoms were decreased appetite 83% (249/300), retro orbital pain 67.6% (203/300), joint pain 67.6% (203/300), pain abdomen 66.6%(200/300) and vomiting 64.3%(193/300). With reference to the signs, majority were with skin rash 57.3% (173/300) followed by hepatomegaly 14.3% (43/300). With reference to the complications 19% (57/300) of the children had complications, of which most common were hepatic dysfunction 11% (33/300) and pleural effusion 3.6% (11/300).There were no deaths. Average duration of stay in hospital was 6 10 days. Tamil Selvan et al JMSCR Volume 03 Issue 08 August Page 7018

3 Table 1: Age and sex pattern of patients with dengue fever Age in years Male Female Total Table 2: Symptoms of dengue fever Symptoms Fever 292(97.3%) Headache 260(86.6%) Myalgia 260(86.6%) Decreased appetite 249(83%) Joint pain 203(67.6%) Retroorbital pain 203(67.6%) Pain abdomen 200(66%) Vomiting 193(64.3%) Skin rash 173(57.6%) Abdominal distension 153(51%) Leg pain 150(50%) Bleeding tendencies a.epistaxis b.petechiae/purpura c.malaena d.subconjunctival haemorrhage 16(5.3%) 7(2.3%) 5(1.6%) 2(0.6%) 2(0.6%) Diarrhoea 16(5.3%) Palpitation 16(5.3%) Oliguria 13(4.3%) Breathlessness 11(3.6%) Altered sensorium 2(0.6%) Convulsions 2(0.6%) Table 3: Signs of dengue fever Signs Skin Rash 173(57.3%) Hepatomegaly 43(14.3%) Torniquet test (positive) 41(13.6%) Ascites 34(11.3%) Spleenomegaly 7(2.3%) Tamil Selvan et al JMSCR Volume 03 Issue 08 August Page 7019

4 Table 4: Complications of dengue fever Complications Hepatic dysfunction 33(11%) Pleural Effusion 11(3.6%) Shock 7(2.3%) Severe Haemorrhage 2(0.6%) Renal failure 2(0.6%) Encephalitis 2(0.6%) Discussion Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. This study describes the clinical profile of current outbreak of dengue fever in children in Bangalore, Karnataka, India. Since the first confirmed case of dengue in India, during the 1940s, intermittent reports from Delhi, 12,13 Ludhiana, 14 Mangalore, 15 Vellore 16 and from other states have been published. The identification is by clinical profile but they can present with varied manifestation There is a steady increase in the outbreak of dengue fever over the years was noted. This is due to the rapid urbanization with unplanned construction activities and poor sanitation facilities contributing fertile breeding grounds for mosquitoes. Due to an increase in the alertness among medical fraternity following the initial epidemic and the availability of diagnostic tools in the hospital have contributed to the increased detection of cases. 17 A outbreak of dengue fever during pre monsoon and monsoon season occurred due to stagnation of water, after bouts of rainfall which facilitate vector breeding. These findings highlight that preventive measures against dengue infection should be taken during water stagnation periods after the initial bouts of rainfall and at the end of monsoon. Among the age and sex majority of the cases were in the age group of 6-10 years with 36% followed by more than 10 years with 31%(93/300),and male to female ratio was 1.3:1 and similar pattern was seen in the retrospective analysis of the 2006 North Indian Dengue outbreak 18. This may be due to outdoor activities of these children, where chances of getting bitten with mosquitoes are more. Among the symptoms and signs, fever 97.3%, headache 86.6%, myalgia 86.6% were common symptoms and skin rash 57.3% and hepatomegaly 14.3% were common signs as with other studies. Among the complications, present study reveals 19% which is less when compared to other studies of Horwarth from Australia 19 and Sharma from India. 20 who reported 63% and 69% respectively. With reference to the death, none of them died in our study, indicating less severity. This may be due to presence of less virulent organisms during current outbreak. Conclusion Clinical profile resembles with other studies but with low severity and most common complication being hepatic dysfunction. Community awareness, early diagnosis and management and vector control measures and vaccination need to be strengthened in order to reduce the increasing number of dengue case. Bibliography 1. World Health Organization; Dengue and Dengue Hemorrhagic fever. Available in centre/factsheets./ fs117/en/accessed on Guzmán MG, Kourí G; Dengue: An update. Lancet Infect Dis., 2002; 2: World health Organization. Dengue and dengue haemorrhagic fever. Fact Tamil Selvan et al JMSCR Volume 03 Issue 08 August Page 7020

5 Sheet.No. 117, Available from:http// heet s/fs117/en/. 4. Dengue in Kerala: A critical review. ICMR Bulletin. 2006;36: Konar NR, Mandal AK, Saha AK. Hemorrhagic fever in Kolkata. J Assoc Physicians India. 1966;14: Abdul Kader MS, Kandaswamy P, Appavoo NC, Anuradha Outbreak and control of dengue in a village of Dharmapuri, Tamil Nadu. J Commun Dis.1997;29: Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai-a study of clinical profile and outcome. Indian Pediatr. 2002;39: Aggarwal A, Chandra J, Aneja S, Patwari AK, Dutta AK. An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi. Indian Pediatr.1998;35: Cecilia D. National Institute of Virology, Golden Jubilee Publication. Dengue Reemerging disease 2004;4: Balaya S, Paul SD, D Lima LV, Pavri KM. Investigations on an outbreak of dengue in Delhi in Indian J Med Res. 1969;5: Chaturvedi UC, Mathur A, Kapoor AK, Mehrotra NK, Mehrotra RM. Virological study of an epidemic of febrile illness with hemorrhagic manifestations at Kanpur, India during Bull World Health Organ. 1970;4: Sulekha C, Kumar S, Philip J. Gullian- Barre syndrome following dengue fever.indianpediatr. 2004;41: Prabhakar H, Mathew P, Marshalla R, Arya M. Dengue hemorrhagic fever outbreak in October November 1996 in Ludhiana, Punjab, India. Indian J Med Res. 1997;106: Faridi M, Anju A, Kumar M, Sarafrazul A. Clinical and biochemical profile of dengue hemorrhagic fever on children in Delhi. Trop Doct. 2008;38: PadibidriVS, Adhikari P, Thakare JP, Ilkal MA, Joshi GD, Pereira P, et al.the 1993 epidemic of dengue fever in Mangalore, Karnataka State, India. Southeast Asian J Trop Med Public Health. 1995;26: CherianT, Ponnuraj E, Kuruvilla T, Kirubakaran C, John TJ, Raghupathy P. An epidemic of dengue hemorrhagic fever & dengue shock syndrome in and around Vellore. Indian J Med Res.1994;100: Gubler DJ. Dengue and dengue hemorrhagic fever. ClinMicrobiol Rev. 1998;11: Chandralekha, Gupta P, Trikha A. The north Indian dengue outbreak 2006: a retrospective analysis of intensive care units admissions in a tertiary care hospital. Trans R Soc Trop Med Hyg. 2008;102: Horvath R, Mcbride WJH and Hanna JN. Clinical features of hospitalized patients during dengue 3 epidemic in Far North Queensland Dengue Bulletin. 1999; 23: Sharma S and Sharma SK. Clinical profile of DHF in adults during 1996 outbreak in Delhi, India. Dengue Bulletin. 1998; 22: Tamil Selvan et al JMSCR Volume 03 Issue 08 August Page 7021

A Clinical Profile of Dengue in Children of Tertiary Care Hospitals in Davangere

ORIGINAL ARTICLE pissn 0976 3325 eissn 2229 6816 Open Access Article www.njcmindia.org A Clinical Profile of Dengue in Children of Tertiary Care Hospitals in Davangere Vanitha SS 1, Sandhyarani Javalkar